Laserfiche WebLink
•477PERMIT APPLICATION II/ <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) j PROJECT SITE INFORMATION GV <br /> t / n � <br /> PROJECT SITE ADDRESS: t `(\l -t ( ) > PROPERTY TAX#:V1( 1 I(L�,1 2 J tF2 �r'Y <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> COWNER NAME: � t `4- ,C� <br /> (jF'v+'1 5 c({" ha. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDR : STREET {'J�fy1/ \AiH161D re- /- . <br /> IN <br /> C _.-V t'V- STATE VA ZIP C/I ? <br /> OWNER PHONE: I`f(Z5-( 5 9--. 7, 7- R OWNER EMAIL: COSgC.ifias s rk4 pi/leas-Lk, rit`7- <br /> CONTRACTOR NAME: ' CV4_,- 11C r <br /> CONTRACTOR ADDRESS: STREET t (3-7-/'\ £p�' k C f ty/� <br /> I-4 <br /> CITY ti 611 fir)(I, STATE WA ZIP �1fJ 1°' 0, <br /> CONTRACTOR PHONE: `"t Z -f 4 - r3 4--7---R- CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): AIL(,L(L...C-(l(4 if, (2 \ l.i2 CITY OF EVERETT BUSINESS LICENSE!!(REQUIRED) /�,,2- <br /> PRIMARY CONTACT: 0 OWNER .4:CONTRACTOR 0 OTHER(Please Specify) <br /> CONTilt7!NAME: CONTACT PHONE: {--(? a{•-� 4- 2, (7 7,,•l.3(`{-P 1 �� ,i A'(711 C CONTACT EMAIL: j 1 kty"\ o ; K1,[t <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ t ,2'3 0 <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ta'ther r'1 O [�,/C% :-kf p•--- <br /> Building <br /> Building Type: ❑SFR-DetachedFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New 54ddition 12 Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ['Demolition ti Change of U'se V <br /> DESCRIPTION OF WORK. <br /> TA/ ;A.t-7V.0 A r(--i'OYA 0(I:- b.-0 , (--c,----- s-yo-4,4 . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration _Repair Type of Project: New _Addn _Alteration Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems •• Unit Heater Bathtub Urinal <br /> Gas Piping ( f ) Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemi/gal for Water 1 No.of Heads <br /> ACKNOWLEDGE EENT;I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before l eing . 'zed under any circumstance.I am the owner.or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with/the Contrac.s Law 1 .27 RCW and 296.200A WAC. <br /> i / City of Everett Official Use Only <br /> fi ) /�! t _ 7:/ PERMIT �� <br /> Owner/Aut briied Agent •nature l.,,i Date (Revised 9/23/2016) <br />